Thursday, April 21, 2011

It can't be thrush if you don't have the right symptoms, right?

We've got thrush (also known as a yeast infection of the mother's breast/baby's mouth).
We don't look like we've got it, and so we didn't figure it out for a long time.
But we do have it.
I'm writing today in the hopes that maybe someone else will read this and be able to spare themselves six months of pain by correctly diagnosing their own thrush MUCH faster than we did!

I was pretty sure we got our first case of yeast late last December. It seemed logical to me to have a sugar overgrowth during Christmas cookie season, and then my breasts got sore and nursing started to hurt. Around the first of the year I did a several day intensive no-sugar-or-yeast-in-any-form diet, and it cleared up. Problem solved!

Then in early March or so I started having shooting pain when we nursed, and thought it might be thrush, but I didn't have the classic symptoms (redness or itching), and when I tried a nipple cream (for the pain) it improved within hours. So my local *IBCLC and I concluded that perhaps it had just been chapped nipples. It can't be thrush if you don't have the symptoms, right?

*(international board certified lactation consultant)

But it is back. A few days ago, literally overnight, we went from normal to nursing pain so intense that I was considering forcing Eagle to wean cold-turkey that day. When he latched on it felt like dozens of needles or knives were stabbing into me, fire radiating out from the nipple and up through my breast. It continued and only increased during the nursing, and when he was done it hurt to put my bra back on. I refused him the breast most of the day because it hurt so much.
But it can't be thrush if you don't have the right symptoms, right?
After putting Eagle to bed that night I happened to be chatting online with a friend of mine who lives in another state. I had forgotten that she is an IBCLC, but when I mentioned the pain she said "that sounds like yeast." I explained that I used to think so to but then the situation in March had left me with the conclusion that no, it wasn't yeast because my symptoms were wrong. I suspected that the pain was a combination of chapped nipples and Eagle getting 6 new teeth in the last month. She asked me what my symptoms were.  I told her. She told me that she would bet money that it was yeast. Apparently she had had a similar non-typical-symptomatic case of thrush, and it took 6 months for her lactation consultant to figure out what it was. That's part of why she decided to become an IBCLC herself. She sent me to a couple of websites with more comprehensive lists of yeast/thrush symptoms (especially Dr Jack Newman's page here), and it was eye-opening.

Here is an excerpt from another breastfeeding site:
Symptoms in the mother include severe stinging, burning pain, which may be on the surface of the nipples, or may be felt deep inside the breast. Pain often continues throughout the feeding and in between feedings - especially immediately after. (Nipple pain caused by incorrect positioning and latch on rarely hurts except when the baby is nursing). Sometimes sharp, shooting pain radiates from the nipple into the breast or into the back or arm. Nipples are sensitive to light touch, so it may hurt to have clothes rubbing against them, and it may be very painful to take a shower and have the hot water spray touch the breast. Mothers describe the pain as 'liquid fire', 'hot needles', 'razor blades', 'a piece of glass stuck in my nipple', etc. I've heard many mothers say that they would rather go through labor again than have yeast on their nipples or in their milk ducts, which gives you an idea of just how painful this condition is.
So I concluded that we definitely have yeast. I started doing some things at home, but also made an appointment to go in to the doctor to get nystatin. Nystatin is an anti-fungal, and designed specifically to be safe to ingest. Gentian violet is a common "natural" treatment for thrush, but it is NOT supposed to be ingested, and since we're dealing with the inside of my baby's mouth...well, I felt like I'd like to get some nystatin. So we went to the doctor. She looked in his mouth and said nope, he doesn't have thrush. He does have some markings on his tongue, but apparently that is just a geographic tongue, which is not the same. (As an interesting note, though, now that I'm reading up on geographic tongue, though it is considered benign, it can be overcome by doing basically the same things as you do to treat yeast...)
The nipples may look puffy, scaly, flaky, weepy, or have tiny blisters. They may be itchy. The color is often a deep pink. The nipples may also look completely normal, but be terribly painful (just as the baby's mouth may be infected, but not have white patches). Generally, the nipples don't "look as bad as they feel', so there is often a tendency to underestimate the severity of the problem based simply on visual examination of the nipples. If you have yeast on your nipples, or if your baby has it in his mouth, your milk supply will often decrease. Pain inhibits the let-down reflex, and babies with yeast often do not nurse as efficiently as they do when their mouths are not sore. Yeast infections may also lead to plugged duct and mastitis.

Oh, wait, supply may decrease? Hmm, so perhaps this is why a few months ago (maybe around December?!) Eagle started nursing twice as often as he previously had?
And the baby (and mom) can have thrush without anything visible on the mouth/nipple? So, in other words, if our symptoms show it, we SHOULD be treating it, even if the doctor says we don't have it.

In any case, it seems are are left with treating this entirely on our own. So here is what we are doing, in case you want to know:
  • Treat both mom's nipples and baby's mouth, even if only one (or neither) of you has visible symptoms. Any topical treatments will probably get to both of you anyway.
  • Probiotics. I am taking 50 billion (no, that's not a typo) at least 50 billion organisms of probiotics per day. The best probiotics are the ones that have to be refrigerated, but if you can't find that then find something with multiple kinds of bacilli in it, and that has a high enough dosage. 
  • Coconut oil. Eat several Tbs a day if you can (be careful, too much will give you the runs...but at least a couple Tbs a day!) Also use it externally on your nipples.
  • Stop eating sugar, especially refined sugar. You can allow yourself minimal amounts of natural sugar (in fruit, for example) but try to stick with lower-sugar content foods even there. Here is a list with the sugar content of some common fruits.
  • Get some ultraviolet rays on your affected parts. You could go tanning, or you could sunbathe topless. At the very least, try some topless nursing next to a big open window. Bring a book and stay a while. (Lucky for me, I live on the second story, and none of my nearby neighbors have second stories, so I can get away with this!)
  • Gentian violet, as I mentioned, is commonly recommended as a treatment for thrush. It is an anti-viral, and I have been using it, but I am doing so with care. I followed Dr Jack Newman's guide for how to put it on (great advice about putting olive oil on the baby's face first!) but due to the risks about ingesting it, I put it on AFTER the baby nurses rather than before, or I put it on and let it dry completely (at least several minutes) before he nurses. That way I am minimizing any ingestion. Also, as a note, if you use GV, be sure to use nursing pads and/or an old bra--I did both and still got purple stains on my bra. I also laid an old blanket in my baby's bed before putting him down, so any drool or dribbles would be on the old blanket rather than a nice one--and I'm very glad I did so!
  • Grapefruit Seed Extract (not grape seed extract!!) I have not tried this yet (I'm going shopping to look for it this afternoon), but I've heard other mothers swear by it. Dr Jay Gordon has a page explaining why he recommends this over other treatments, and also how to use it.
  • I have been making daily smoothies, with my 5Tbs of liquid probiotics, 2 Tbs of coconut oil, half a banana, 4-5 frozen strawberries, and a little milk to smooth it out.  Last night we made a batch of unflavored/unsweetened yogurt so today I'll use that instead of the banana. The coconut oil clumps up a bit when it's that cold, so you have to let it mix in the blender for about a whole minute. It's pretty good!

This page has links to just about anything and everything you might need or want to know about thrush (including most of what I've linked in this post).


TopHat said...

I'm a grapefruit seed extract person. Isaac hated the taste (so do I!). And sunlight. Isaac had thrush in his diaper, and some bare bum sun time worked well! Also good for nipples. :)

Jenni said...

For what it's worth, the new smoothie was SOUR!!! I will do it with a banana again tomorrow. I could barely choke it down and I don't usually mind sour things.

Valerie said...

Thanks so much for posting this. Lore and I had thrush for a while and we also had A-typical symptoms. I didn't figure out it was thrush till she had a diaper rash from the yeast so bad that it was almost bleeding and would not go away. She had at that point no white patches and I was not having any pain but she just was not nursing right and was very fussy about latching on. I knew somthing was wrong then because she is usually like a little prana when she latches on. I think the more attention needs to be paid to the less common symptoms. Glad you are working through it. I will be adding coconut oil to my smoothies from now on.

AC said...

ouch, this sounds painful. With my first I got plugged ducts a few times and I thought that was painful. I've been lucky with my second so far, but thank you for your post, it's very informative.

Mallory said...

Good luck beating the thrush! When I had it with Bug, we tried GSE, and it helped a little. But it was also irritating Bug's mouth and my nipples. We ended up getting rid of the yeasties with three treatments of GV. Not what I had hoped, but at least it got rid of it!

maridee said...

My baby is dealing with thrush right now to. I have managed not to get it. I have been putting melalueca essential oils on my nipples. I felt better about getting this in my baby's mouth because it is safe to ingest and will also help treat the baby's mouth. It is ONLY safe if you use certified pure therapeutic grade essential oils. Not all oils are created equal. Give it a try. Good Luck. I am happy to give more info if you would like it.

Brasileira said...

Your symptoms of shooting pain, like dozens of tiny knives, is exactly what I had when Jordan was a newborn. My nipples and his mouth were totally normal. But the slicing knives, deep inside the breast, continued for a month until I got a prescription from my doctor (who didn't believe in yeast infections at all, but he was a dumb doctor). Yogurt, no sugar, vinegar, etc did not help. Only the prescription. That is why I will never allow myself any antibiotics while breastfeeding again. It hurts!

Sassy Sarah said...

Great info! Thanks for sharing. :-)

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